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Journal of Evaluation in Clinical... Oct 2022Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds,... (Review)
Review
Since its foundation in 2010, the annual philosophy thematic edition of this journal has been a forum for authors from a wide range of disciplines and backgrounds, enabling contributors to raise questions of an urgent and fundamental nature regarding the most pressing problems facing the delivery and organization of healthcare. Authors have successfully exposed and challenged underlying assumptions that framed professional and policy discourse in diverse areas, generating productive and insightful dialogue regarding the relationship between evidence, value, clinical research and practice. These lively debates continue in this thematic edition, which includes a special section on stigma, shame and respect in healthcare. Authors address the problems with identifying and overcoming stigma in the clinic, interactional, structural and phenomenological accounts of stigma and the 'stigma-shame nexus'. Papers examine the lived experience of discreditation, discrimination and degradation in a range of contexts, from the labour room to mental healthcare and the treatment of 'deviancy' and 'looked-after children'. Authors raise challenging questions about the development of our uses of language in the context of care, and the relationship between stigma, disrespect and important analyses of power asymmetry and epistemic injustice. The relationship between respect, autonomy and personhood is explored with reference to contributions from an important conference series, which includes analyses of shame in the context of medically unexplained illness, humour, humiliation and obstetric violence.
Topics: Child; Delivery of Health Care; Humans; Philosophy; Respect; Shame; Social Stigma
PubMed: 36053567
DOI: 10.1111/jep.13755 -
Child Psychiatry and Human Development Dec 2021Self-conscious emotions, like shame and pride, are thought to have an evaluative component in which the self is posited against a set of standards, rules, and goals of...
Self-conscious emotions, like shame and pride, are thought to have an evaluative component in which the self is posited against a set of standards, rules, and goals of society. This study compares the two methods used to examine self-conscious emotions: a self-report questionnaire, the Test of Self-Conscious Affect in Children (TOSCA-C), and a direct observation of behaviors in response to particular tasks, developed by Lewis, Alessandri and Sullivan (1992). 126 young children participated in both tasks at ages 6 and 7. For the observation data, we found that the tendency to be self-evaluative in terms of success were not related to be self-evaluative in failure, and individual consistency across age was found for self-conscious emotions but not for the primary emotions. The questionnaire data showed that children who scored high in shame also scored high in failure, and there were no consistencies across age. There were weak, inconsistent associations between shame measured by the questionnaire technique and sadness observed in the experiment.
Topics: Child; Child, Preschool; Emotions; Guilt; Humans; Self Concept; Self-Assessment; Shame
PubMed: 33185804
DOI: 10.1007/s10578-020-01094-2 -
Journal of Evaluation in Clinical... Oct 2022Stigma has been associated with delays in seeking treatment, avoiding clinical encounters, prolonged risk of transmission, poor adherence to treatment, mental distress,...
Stigma has been associated with delays in seeking treatment, avoiding clinical encounters, prolonged risk of transmission, poor adherence to treatment, mental distress, mental ill health and an increased risk of the recurrence of health problems, among many other factors that negatively impact on health outcomes. While the burdens and consequences of stigma have long been recognized in the health literature, there remains some ambiguity about how stigma is experienced by individuals who live with it. The aim of this paper is to elucidate the phenomenology of stigma, or to describe how it is that stigma shows up in the first-person experience of individuals who live with stigma and its burdens. Exploring the relationship between shame and stigma, I argue that shame anxiety, or the chronic anticipation of shame, best characterises the experience of living with a health-related, or health-relevant, stigma. Understanding the experiential features, or phenomenology, of shame anxiety will give healthcare professionals a greater sensitivity to stigma and its impacts in clinical settings and encounters. I will conclude by suggesting that 'shame-sensitive' practice would be beneficial in healthcare.
Topics: Anxiety; Anxiety Disorders; Humans; Mental Health; Shame; Social Stigma
PubMed: 35903848
DOI: 10.1111/jep.13744 -
Clinical Ethics Jun 2024This paper is particularly concerned with shame, sometimes considered the 'master emotion', and its possible role in affecting the consent process, specifically where...
This paper is particularly concerned with shame, sometimes considered the 'master emotion', and its possible role in affecting the consent process, specifically where that shame relates to the issue of diminished health literacy. We suggest that the absence of exploration of affective issues in general during the consent process is problematic, as emotions commonly impact upon our decision-making process. Experiencing shame in the healthcare environment can have a significant influence on choices related to health and healthcare, and may lead to discussions of possibilities and alternatives being closed off. In the case of impaired health literacy we suggest that it obstructs the narrowing of the epistemic gap between clinician and patient normally achieved through communication and information provision. Health literacy shame prevents acknowledgement of this barrier. The consequence is that it may render consent less effective than it otherwise might have been in protecting the person's autonomy. We propose that the absence of consideration of health literacy shame during the consent process diminishes the possibility of the patient exerting full control over their choices, and thus bodily integrity.
PubMed: 38778880
DOI: 10.1177/14777509231218203 -
Ugeskrift For Laeger May 2022Non-suicidal self-injury (NSSI) is prevalent among adolescents and a sign of suffering. The behaviour is often associated with shame, and professionals are unsure of how... (Review)
Review
Non-suicidal self-injury (NSSI) is prevalent among adolescents and a sign of suffering. The behaviour is often associated with shame, and professionals are unsure of how to inquire about it. The implication is that many young people do not tell about their NSSI. This review introduces a short and easy-to-use screening tool called "The 3 F's". By means of "The 3 F's" the form, the frequency and the function of NSSI can be uncovered. The screening tool can be used for systematic detection of NSSI in order for professionals in a respectful way and with a validating attitude to show the adolescent that they wish to understand the underlying cause of the self-injuring behaviour.
Topics: Adolescent; Humans; Research; Self-Injurious Behavior; Shame
PubMed: 35506620
DOI: No ID Found -
Journal of Clinical Medicine Nov 2022the role of self-conscious emotions (SCE) such as shame and guilt in eating disorders (ED) has been systematically studied only in recent years, but it is still debated....
BACKGROUND
the role of self-conscious emotions (SCE) such as shame and guilt in eating disorders (ED) has been systematically studied only in recent years, but it is still debated. This study aims to investigate the role of SCE in anorexia nervosa (AN), evaluating the role of self-consciousness.
METHODS
fifty-five individuals with AN and seventy-four healthy controls (HC) were enrolled and completed a battery of tests evaluating the proneness to feel shame and guilt, as well as comparing self-consciousness, eating, and general psychopathology.
RESULTS
individuals with AN showed a higher proneness to shame. Shame was correlated with body dissatisfaction and drive for thinness, which are core symptoms in AN, after controlling for scores of depression and anxiety. Proneness to guilt seemed to be less correlated with eating and body symptomatology, but it appeared to have a negative correlation with binge-purging symptoms. Furthermore, proneness to shame was independent of guilt or self-consciousness and the two groups did not differ regarding public and private self-consciousness.
CONCLUSIONS
shame is an important and independent factor in AN. Future research may offer progress in the development of shame-focused therapies.
PubMed: 36431160
DOI: 10.3390/jcm11226683 -
Seizure Jan 2022
Topics: COVID-19; Child; Conversion Disorder; Humans; SARS-CoV-2; Seizures; Shame
PubMed: 34875543
DOI: 10.1016/j.seizure.2021.11.025 -
Journal of Evaluation in Clinical... Oct 2022The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this...
BACKGROUND & AIMS
The emotional underpinnings that facilitate and complicate the practice of ethical principles like respect warrant sustained interdisciplinary attention. In this article, I suggest that shame is a requisite component of the emotional repertoire than makes respect for persons possible.
MATERIALS & METHODS
I use person-centered interview data from a sample of 54 physicians (including 35 surgeons), 60% of whom are women, to examine the emergence and endurance of shame as a mood with moral significance. Drawing on anthropologist Throop's concept of a moral mood, I explore physicians' first-person narratives of the endurance of shame experiences.
RESULTS
Narratives demonstrate that shame inheres in biomedical contexts that reinforce the physician's responsibilization and culpability for events beyond their control. As a persistent cognitive and affective state, mooded shame is a recursive and compulsory motive force for a physician's dynamic evolution as a moral actor.
DISCUSSION
Variably distressing, looming and commonplace, mooded shame becomes an atmospheric and imaginative mode through which physicians contemplate their responsibilities and connections to patients. Sometimes in a hypercognized manner that conceals its emotional roots, physicians link the mood of shame to their incessant efforts to fulfill responsibilities to each unique patient.
CONCLUSION
I suggest that through reflection made possible within mooded shame, physicians develop a sense of being both accountable to and alongside patients, and I explore the ties between this position and philosophical concepts of respect.
Topics: Affect; Emotions; Female; Humans; Male; Morals; Physicians; Shame
PubMed: 35655432
DOI: 10.1111/jep.13708 -
The British Journal of Clinical... Mar 2023Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed.
OBJECTIVES
Our review systematically examines the association of shame with OCD and unacceptable thoughts.
METHODS
The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model.
RESULTS
The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [-0.467, 0.9708], harm obsessions r = .224, CI [-0.190, 0.638] and symmetry concerns r = .200, CI [-0.108, 0.509].
LIMITATIONS
Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant.
CONCLUSIONS
Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.
Topics: Humans; Quality of Life; Obsessive-Compulsive Disorder; Shame; Psychiatric Status Rating Scales; Psychometrics
PubMed: 36300990
DOI: 10.1111/bjc.12392